The present invention relates to an electrosurgical tool which is adapted to simultaneously cut, fuse, and cauterize the cut tissue so as to improve hemostasis.
Surgical procedures often require incisions to be made in internal organs, such as the intestine, causing profuse bleeding at the site of the incision. Prompt control or elimination of the bleeding is of paramount importance to the success and safety of the procedure.
Currently known surgical cutting devices utilize different techniques to control or eliminate bleeding. One known device is the Proximate Linear Cutter available from the Ethicon, Inc. of Somerville, N.J. This device is specifically adapted to make an incision in tissue or an organ such as the intestine. The device engages a portion of the tissue or organ between two tyne-like members. To effect cutting, a blade mounted on one of the tynes travels along a predetermined path, thereby making a linear incision through the tissue or organ. Simultaneously, surgical staples are deployed by the cutting device on either side of the incision, resulting in the separation of the organ into two segments, each of which is sealed adjacent to the incision by surgical staples. Despite the use of surgical staples and the precise cutting of the tissue, bleeding is not entirely eliminated and separate cauterization procedures must often be utilized to control or stop bleeding.
Surgical devices also are known which utilize electrical current in the form of radio frequency (RF) energy to cauterize tissue and to prevent or control bleeding. U.S. Pat. No. 4,651,734 discloses a surgical scalpel modified to include an electrode. This scalpel has the ability to cut tissue and, when properly positioned, to cauterize tissue following a cutting procedure. Such a surgical tool is useful but does not simultaneously cut and cauterize tissue. The separate cauterization procedure which must be utilized is relatively time consuming and may result in unnecessary bleeding. Moreover, such a scalpel is not well suited to many surgical procedures such as the transection of the intestine.
Accordingly, there is a need for a surgical tool which conveniently and safely enables precise incisions to be made in internal organs, and which simultaneously is able to eliminate essentially all bleeding which results from the incision.
It is thus an object of the invention to provide a surgical tool which has improved cutting capability and which decreases some of the risk associated with surgery by minimizing the amount of bleeding resulting from incisions. Another object is to provide a surgical tool which is adapted to simultaneously cut tissue and to cauterize the cut tissue. A further object is to provide an electrosurgical tool which is specifically adapted to make linear incisions in internal organs and, simultaneously, to fuse the tissue adjacent to the incision in order to eliminate any associated bleeding. It is also an object of the invention to provide such a surgical device that does not require a sharpened surgical blade to sever tissue. Other objects of the invention will be apparent upon reading the disclosure which follows.
The present invention comprises an electrosurgical cutting tool which is able to effect a precise incision through tissue, while at the same time ensuring that essentially all of the bleeding which results from the incision is controlled or eliminated. The electrosurgical cutting tool features a housing which includes a handle portion and a cutting template element which is disposed adjacent to the handle portion of the housing. The cutting template preferably includes first and second elongate tyne elements which define a tissue engaging space. A first tyne element includes a retractable cutting element which is adapted to travel along a linear cutting path defined within the first tyne. The cutting element is electrically insulated from the remainder of the tool and is in electrical communication with an active electrode which provides a source of electrosurgical energy to the blade. The surgical cutting tool of the invention also includes a mechanism, preferably located on the handle, which controls the movement of the cutting element along the cutting path.
The electrosurgical cutting tool may be a bipolar device or a monopolar device. In the preferred bipolar configuration an active electrode supplies electrical current to the cutting element, and a return electrode is disposed on a tissue-contacting portion of the second tyne. A return electrode is not integrally associated with the tool when it is configured as a monopolar device. Instead, a ground plate, remote from the tool itself, is positioned to contact a portion of the patient""s body.
The cutting element can be a sharpened blade, an electrode wire, a conductive material, or a conductive coating formed on a non-conductive substrate. The cutting element does not necessarily require a level of sharpness typically associated with conventional surgical cutting tools.
The delivery of electrosurgical energy through the cutting element, whether a sharpened blade or not, enhances, the cutting performance and more importantly, facilitates cauterization and/or fusion of the tissue following the incision. It has been found that the use of radio frequency energy in connection with the cutting tool effectively allows the simultaneous cutting, cauterizing and fusing of tissue adjacent the incision in order to eliminate virtually all resulting bleeding.
In another embodiment of the invention a plurality of surgical staples may be deployed by the device during a cutting procedure. In this embodiment a surgical staple cartridge is disposed within the first tyne, defining a central longitudinal groove through which the cutting element is able to travel. The surgical staple cartridge includes a plurality of staples, preferably disposed in dual rows on either side of the longitudinal groove. Upon movement of the cutting element, a staple ejecting device travels with the element along the length of the staple cartridge causing the staples to be deployed through the tissue. A staple closing anvil preferably is disposed in the second tyne to effect closure of the staples. This embodiment is advantageous as it allows the tissue to be cut, and at the same time, enables a row of staples to be deployed adjacent the incision while electrical current is passed through the cutting element to eliminate bleeding by effecting cauterization and tissue fusion. In some instances it may be desirable to deliver electrosurgical energy through the surgical staples as well as through the cutting element.